Provider Demographics
NPI:1831832930
Name:JAHAN, MOSAMMAT ISRAT (FNP)
Entity type:Individual
Prefix:
First Name:MOSAMMAT
Middle Name:ISRAT
Last Name:JAHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677879
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32867-7879
Mailing Address - Country:US
Mailing Address - Phone:407-440-3004
Mailing Address - Fax:407-429-3899
Practice Address - Street 1:4882 QUALITY TRAIL
Practice Address - Street 2:BILLING OFFICE ONLY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829
Practice Address - Country:US
Practice Address - Phone:407-440-3004
Practice Address - Fax:407-429-3899
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner